Leukocytapheresis Therapy of Inflammatory Bowel Disease

  • Takanori KanaiEmail author


Inflammatory bowel disease (IBD), which includes ulcerative colitis (UC) and Crohn’s disease (CD) is a chronic relapsing-remitting immune disorder that afflicts millions of individuals throughout the world with debilitating symptom impairing performance and quality of life. The chronic nature of IBD means that afflicted individuals need life-long medications and this can lead to drug dependency, loss of response together with medication related adverse side effects as additional morbidity factors. In recent years, the efficacy of anti-tumor necrosis factor (TNF)-α antibodies like infliximab in patients with IBD has validated the role of certain cytokines, notably TNF-α in the immunopathogenesis of both UC and CD. However, a major source of inflammatory cytokines are myeloid lineage leukocytes (granulocytes and monocytes), which in patients with IBD are elevated with activation behavior and prolonged survival time. Therefore, myeloid leukocytes appear to be logical target of therapy in IBD patients. Based on this knowledge, therapeutic leukocytapheresis has been introduced as a non-pharmacologic treatment intervention in patients with active IBD. In early days, centrifugation was applied to deplete the myeloid leukocytes, but this has been replaced by direct hemoperfusion systems, the Adacolumn and the Cellsorba filter column. The Adacolumn is filled with cellulose beads as leukocytapheresis carriers that selectively adsorb myeloid leukocytes together with a significant fraction of platelets. In contrast, the Cellsorba filter removes lymphocytes in addition to myeloid cells. The efficacy rate for leukocytapheresis has been variable, from an 80 % to statistically insignificant level depending on patients’ baseline disease severity and other relevant demographic variable. First episode cases together with steroid naïve patients have responded well, while patient with extensive deep mucosal IBD lesions have not responded. However, leukocytapheresis therapy in IBD holds promise, but the full efficacy of this non-drug strategy warrants additional controlled trials in large cohorts of IBD patients.


Inflammatory bowel disease Ulcerative colitis Crohn’s disease Extracorporeal cytapheresis Adacolumn Cellsorba 


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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Division of Gastroenterology and Hepatology, Department of Internal MedicineKeio University School of MedicineTokyoJapan

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